葡萄糖钠转运体 2 抑制剂在糖尿病和心力衰竭成人患者中的实际使用情况和疗效：加拿大艾伯塔省人群队列研究》。

IF 2.3 4区医学 Q3 ENDOCRINOLOGY & METABOLISM

Canadian Journal of Diabetes Pub Date : 2024-07-01 DOI:10.1016/j.jcjd.2024.03.004

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引用次数: 0

摘要

目的：自2016年起，临床指南推荐2型糖尿病合并心衰患者使用SGLT2i。我们研究了糖尿病合并心衰患者的SGLT2i配药、配药相关因素、心衰住院率和全因死亡率：这项基于人群的回顾性队列研究确定了 2014 年 1 月 1 日至 2017 年 12 月 31 日期间加拿大艾伯塔省的糖尿病合并心力衰竭患者（430 万人口），并对他们进行了至少三年的随访。多变量逻辑回归评估了与SGTL2i配药相关的因素。使用倾向评分和回归调整来估计 SGLT2i 治疗对心力衰竭住院治疗的影响：在 22025 名糖尿病合并心力衰竭患者中（43.4% 为女性，平均年龄为 74.7 ± 11.8 岁），仅有 10.2% 的患者接受了 SGLT2i 治疗。男性、年龄小于 65 岁、基线 A1C 较高、无慢性肾病、患有动脉粥样硬化性心血管疾病以及居住在城市与 SGLT2i 的配药有关。观察发现，使用 SGLT2i 的患者（548.1/100 人-年）与未使用 SGLT2i 的患者（813.5/1000 人-年；p 结论：使用 SGLT2i 的患者心力衰竭住院率较低，而未使用 SGLT2i 的患者心力衰竭住院率较高：只有10%的糖尿病合并心力衰竭患者获得了SGLT2i，这说明在护理方面还存在很大差距。在现实世界中，使用 SGLT2i 可减少心衰住院和全因死亡。这项研究强调了优化 SGLT2i 使用的重要机会。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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Real-world Use and Outcomes of Sodium-Glucose Cotransporter-2 Inhibitors in Adults With Diabetes and Heart Failure: A Population-level Cohort Study in Alberta, Canada

Objectives

Since 2016, clinical guidelines have recommended sodium-glucose cotransporter-2 inhibitors (SGLT2is) for people with type 2 diabetes with heart failure. We examined SGLT2i dispensation, factors associated with dispensation, and heart failure hospitalization and all-cause mortality in people with diabetes and heart failure.

Methods

This retrospective, population-based cohort study identified people with diabetes and heart failure between January 1, 2014, and December 31, 2017, in Alberta, Canada, and followed them for a minimum of 3 years for SGLT2i dispensation and outcomes. Multivariate logistic regression assessed the factors associated with SGTL2i dispensation. Propensity scores were used with regression adjustment to estimate the effect of SGLT2i treatment on heart failure hospitalization.

Results

Among 22,025 individuals with diabetes and heart failure (43.4% women, mean age 74.7±11.8 years), only 10.2% were dispensed an SGLT2i. Male sex, age <65 years, a higher baseline glycated hemoglobin, no chronic kidney disease, presence of atherosclerotic cardiovascular disease, and urban residence were associated with SGLT2i dispensation. Lower heart failure hospitalization rates were observed in those with SGLT2i dispensation (548.1 per 100 person-years) vs those without (813.5 per 1,000 person-years; p<0.001) and lower all-cause mortality in those with an SGLT2i than in those without (48.5 per 1,000 person-years vs 206.1 per 1,000 person-years; p<0.001). Regression adjustment found SGLT2i therapy was associated with a 23% reduction in hospitalization.

Conclusions

SGLT2is were dispensed to only 10% of people with diabetes and established heart failure, underscoring a significant care gap. SGLT2i use was associated with a real-world reduction in heart failure hospitalization and all-cause death. This study highlights an important opportunity to optimize SGLT2i use.

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来源期刊

Canadian Journal of Diabetes ENDOCRINOLOGY & METABOLISM-

CiteScore

4.80

自引率

4.00%

发文量

130

审稿时长

54 days

期刊介绍： The Canadian Journal of Diabetes is Canada''s only diabetes-oriented, peer-reviewed, interdisciplinary journal for diabetes health-care professionals. Published bimonthly, the Canadian Journal of Diabetes contains original articles; reviews; case reports; shorter articles such as Perspectives in Practice, Practical Diabetes and Innovations in Diabetes Care; Diabetes Dilemmas and Letters to the Editor.